经皮穿肝胆道引流（PTBD）结合经动脉灌注化疗（TAI）治疗胰头癌伴梗阻性黄疸.pdf

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1、复里学握(医学版)222FudanUnivJMedSci经皮穿ii~ll_a道引流(PIeD)结合经动脉灌注化疗(TAI)治疗胰头癌伴梗阻性黄疸李长煜王小林龚高全程洁敏李国平刘凌晓施惠斌陈颐。复旦大学附属中山医院介入治疗科上海200032；上海市影像医学研究所上海200032)【摘要】目的评价经皮穿肝胆道引流(percutaneoustranshepaticbiliarydrainage，PTBD)结合经动脉灌注化疗(transarterialinfusion，TAD治疗中晚期胰头癌伴梗阻性黄疸的临床价

2、值。方法回顾性收集伴有梗阻性黄疸的胰头癌患者28例，所有患者均先行PTBD解除胆道梗阻症状，待有效引流后行经动脉灌注化疗。分析患者的临床受益反应(clinicalbenefitresponse，CBR)、支架通畅时间、生存期和并发症。结果28例患者共行PTBD28次，胆红素由术前(168．9±64．1)“mol／L降到术后最低(37．2±6．2)tzmol／L，其中15例放置胆道支架，支架平均通畅时间为10．6个月，共接受经动脉灌注化疗81次，所有病例均未出现Ⅲ～Ⅳ不良反应，总临床受益反应为64．3，平

3、均生存期7．O7个月。结论PTBD结合经动脉灌注化疗是治疗中晚期胰头癌伴梗阻性黄疸患者安全可行的办法。【关键词】胰腺癌；梗阻性黄疸；经皮穿肝胆道引流(PTBD)；经动脉灌注化疗(TAI)【中图分类号】R735．9【文献标志码】Bdoi：10．3969／j．issn．1672-8467．2014．01．014Percutaneoustranshepaticbiliarydrainage(PTBD)combinedwithtransarterialinfusion(TAI)intreatmentofpanc

4、reaticheadcancerwithobstructivejaundiceLIChang—yu'，WANGXiao—lin’。，GONGGao—quan’，CHENGJie—min’，LIGuo—ping，，LIULing—xiao'，SHIHui—bin，，CHENYi’，△(DepartmentofInterventionalRadiology，ZhongshanHospital，FudanUniversity，Shanghai200032，China；ShanghaiInstituteofMe

5、dicalImaging，Shanghai200032，China)[Abstract]ObjectiveToevaluatetheclinicalvalueofpereutaneoustranshepaticbiliarydrainage(PTBD)combinedwithtrans-arterialinfusion(TAI)asthetreatmentforadvancedormetastaticpancreaticheadcancerwithobstructivejaundice．MethodsT

6、wenty-eightpatientswhohadbeendiagnosedwithpancreaticheadcancerwithobstructivejaundicewereanalyzedretrospectively．A1lthepatientsunderwenttransarterialinfusionofgemcitabineaftereffectivedrainagebyPTBD．Clinicaloutcomesincludingclinicalbenefitresponse(CBR)，s

7、tentpatencytime，overallsur、，ival(0S)，andcomplicationswereevaluated．ResultsIn28patients，totalserumbilirubinwasdecreasedfrom(168．9±64．1)gmol／Lto(37．2±6．2)t~mol／LafterPTBD．Amongthem15receivedstentimplantationwhosemeanstentpatencytimewas10．6months．Totally81t

8、imesoftrans—arterialinfusionsweredonewithoutIn一Ⅳadversereactions，theproportionofclinica1benefitresponsewas64．3andmeanoverallsurvivalwas7．07months．ConclusionsPTBDcombinedwithTAIisasafeandfeasibletherapyfor1ocallyadvancedorm